VANCOUVER -- The difficult overnight fasting before a cholesterol test may not always be needed for children, a researcher said here.

Action Points

Explain to interested patients that this study suggests that fasting before a cholesterol test may not be needed for many children.

Caution that the research needs to be confirmed.

Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

VANCOUVER -- The difficult overnight fasting before a cholesterol test may not always be needed for children, a researcher said here.

In a population-level study, levels of total cholesterol and high-density lipoprotein cholesterol did not vary with fasting or not, according to Asheley Skinner, PhD, of the University of North Carolina Chapel Hill.

And, while low-density lipoprotein cholesterol did vary, the changes were minimal, Skinner told a scientific session at the meeting here of the Pediatric Academic Societies.

On the other hand, the analysis, involving nearly 11,000 children, showed that triglyceride levels do vary markedly, depending on how long a child fasted before the test, Skinner said.

But the findings suggest, Skinner said, that testing in many cases could take place immediately when needed, rather than waiting for a fasting period, which is often hard on both parents and children.

To see how fasting affects lipid testing, the researchers turned to the National Health and Nutrition Examination Survey 1999-2006, a nationally representative continuing study.

Children three and older taking part in the study were asked to have lipid tests either in a morning or afternoon session.

For the morning sessions, children under 12 were not asked to fast, while those 12 and over were asked to fast overnight. Data on all four lipid measures was collected.

For the afternoon sessions, children were not asked to fast and only data on total cholesterol and high-density lipoprotein cholesterol was collected.

Skinner and colleagues used an ordinary least squares regression to test for differences in lipid values among study participants overall based on fasting times, controlling for weight status, age, race, ethnicity, and sex.

They found:

Total cholesterol and high-density lipoprotein cholesterol data was available for 10,948 children, and 4,424 of those also had low-density lipoprotein cholesterol and triglycerides tested.

48% of the overall group fasted for eight or more hours, and 80% of the group with all four values was fasting.

Fasting time had no significant effect on total cholesterol and high-density lipoprotein cholesterol.

Low-density lipoprotein cholesterol increased 0.46 milligrams per deciliter but there was no significant overall difference between those with and without an eight-hour fast.

In contrast, fasting time had a significant negative effect on triglycerides -- an eight-hour fast resulted in values that averaged 15.6 milligrams per deciliter lower than those with less fasting time.

Skinner concluded that total cholesterol and high-density lipoprotein cholesterol measurements can probably be taken without fasting and the variation in low-density lipoprotein cholesterol measurement "is likely not clinically significant."

While triglyceride levels are affected by fasting, adult research is now showing that non-fasting levels may be better at predicting cardiovascular disease than fasting levels, she added.

Skinner said the study is based on population-level data and needs to be confirmed in patient-level research.

One of the main problems doctors have with cholesterol testing in children is compliance with the fast, said Ivor Horn, MD, of the Children's National Medical Center in Washington, DC, who was not part of the study but moderated the session at which it was presented.

"If we can more effectively interpret that (test) data, we can minimize the burden on families," she told MedPage Today. "The question is do we have enough accuracy in that screen without fasting?"

But, like Skinner, Horn cautioned that more research is needed - on an individual level - to refine and confirm the data.

The study had support from the National Institutes of Health's Building Interdisciplinary Research Careers in Women's Health program and from the National Institute of Child Health and Human Development. Skinner said the authors had no conflicts.

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